Eight Medications That Can Damage the Kidneys if Misused
The kidneys filter waste products, regulate fluid and electrolyte balance, help control blood pressure, and produce hormones involved in red blood cell production and bone health. Many medications are processed through or affect the kidneys. While most are safe when used as directed, some can damage the kidneys if taken in high doses, for long periods, or in people with existing kidney disease or other risk factors.
It’s important to understand that you should not stop any prescribed medication without consulting your healthcare provider. The risk of kidney damage depends on factors such as dose, duration, hydration status, age, other medical conditions, and interactions with other medications.
1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Common examples include:
- Ibuprofen
- Naproxen
- Diclofenac
- Indomethacin
Why can they harm the kidneys?
NSAIDs reduce the production of prostaglandins, substances that help maintain blood flow to the kidneys. In some people, especially those who are dehydrated or have kidney disease, this can reduce kidney blood flow and lead to acute kidney injury.
People at higher risk
- Adults over 65
- People with Chronic kidney disease
- Those with heart failure or liver disease
- People taking diuretics or certain blood pressure medications
- Anyone who is dehydrated
How to reduce the risk
- Use the lowest effective dose for the shortest time needed.
- Stay well hydrated.
- Avoid taking multiple NSAIDs at the same time unless advised by a healthcare professional.
2. Certain Antibiotics
Some antibiotics can be toxic to the kidneys, particularly when given in high doses or to people with reduced kidney function.
Examples include:
- Gentamicin
- Tobramycin
- Amikacin
- Vancomycin (especially at high blood levels)
How they affect the kidneys
These medications may damage kidney tubule cells, leading to reduced kidney function. Hospitals often monitor blood levels and kidney function during treatment with higher-risk antibiotics.
3. Certain Antiviral Medications
Some antiviral medications may affect kidney function or form crystals in the kidneys if not taken with adequate fluids.
Examples include:
- Acyclovir
- Tenofovir disoproxil fumarate
Healthcare providers may recommend dose adjustments or monitoring in people with impaired kidney function.
4. Certain Chemotherapy Drugs
Some cancer treatments can injure the kidneys because they affect rapidly dividing cells or are directly toxic to kidney tissue.
Examples include:
- Cisplatin
- Methotrexate (particularly at high doses)
People receiving these medications are typically monitored closely with blood tests, hydration protocols, and dose adjustments when needed.
5. Contrast Agents Used for Medical Imaging
Contrast dyes used during some imaging procedures (such as CT scans or angiography) can contribute to kidney injury in susceptible individuals.
People at greatest risk include those with:
- Existing kidney disease
- Diabetes
- Dehydration
- Advanced age
Modern contrast agents are generally safer than older ones, and healthcare teams take precautions when appropriate.
6. Proton Pump Inhibitors (PPIs)
Examples include:
- Omeprazole
- Pantoprazole
- Esomeprazole
These medications are commonly used to treat acid reflux and stomach ulcers.
Kidney concerns
Rarely, PPIs have been linked to acute interstitial nephritis, an inflammatory reaction in the kidneys. Some observational studies have also found an association between long-term PPI use and chronic kidney disease, though this does not prove that PPIs directly cause it.
People should use PPIs only when medically indicated and for the duration recommended by their healthcare provider.
7. Certain Diuretics (“Water Pills”)
Examples include:
- Furosemide
- Hydrochlorothiazide
These medications are important treatments for conditions such as high blood pressure and heart failure.
How problems can occur
Diuretics themselves do not usually damage healthy kidneys, but they can contribute to dehydration and electrolyte imbalances. Severe dehydration may reduce blood flow to the kidneys and increase the risk of kidney injury, particularly when combined with NSAIDs or certain blood pressure medications.
8. Lithium
Lithium is an effective medication for treating certain mood disorders.
Kidney risks
Long-term lithium therapy can affect kidney function in some people and may reduce the kidneys’ ability to concentrate urine.
For this reason, people taking lithium usually have:
- Regular blood lithium level checks
- Kidney function tests
- Monitoring for side effects
Despite these risks, lithium remains an important medication for many people when appropriately monitored.
Who Is Most at Risk of Medication-Related Kidney Damage?
The risk is higher in people who have:
- Chronic kidney disease
- Diabetes
- Heart failure
- Dehydration
- Advanced age
- Multiple medications that affect the kidneys
- Recent severe illness, vomiting, or diarrhea
Signs of Possible Kidney Injury
Seek medical attention if you develop symptoms such as:
- Decreased urine output
- Swelling of the legs, ankles, or face
- Persistent nausea or vomiting
- Fatigue or unusual weakness
- Shortness of breath
- Confusion
- Blood in the urine
- Severe flank (side) pain
Kidney injury can also occur without noticeable symptoms, which is why blood and urine tests are often used to monitor kidney function in people taking higher-risk medications.
How to Protect Your Kidneys
To reduce the risk of medication-related kidney problems:
- Take medications exactly as prescribed.
- Avoid using NSAIDs for long periods unless advised by your healthcare provider.
- Stay well hydrated, especially during illness or hot weather.
- Inform your healthcare provider about all prescription drugs, over-the-counter medications, and supplements you take.
- Have your kidney function monitored if you take medications known to affect the kidneys.
- Avoid combining medications that can increase kidney risk unless specifically directed by a healthcare professional.
Key Takeaway
Several medications can affect kidney function, but none should be considered “unsafe” simply because they appear on this list. For many people, these drugs provide important health benefits and can be used safely with proper dosing, monitoring, and medical supervision.
The medications commonly associated with kidney injury include:
- NSAIDs (such as ibuprofen and naproxen)
- Certain antibiotics (especially aminoglycosides and high-risk regimens)
- Certain antiviral medications
- Some chemotherapy drugs
- Contrast agents used in certain imaging procedures
- Proton pump inhibitors (rarely, through kidney inflammation)
- Diuretics (indirectly, if they contribute to dehydration)
- Lithium (with long-term use in some individuals)
If you have kidney disease or are concerned about how a medication may affect your kidneys, discuss it with your healthcare provider before making any changes to your treatment.
